Importance of the sick day rule: a case of prerenal acute kidney injury after COVID-19 vaccination in a patient with chronic kidney disease
Abstract
Chronic kidney disease (CKD) patients have substantially increased risk of severe coronavirus disease 2019 (COVID19) and should be prioritized for vaccination [1]. We report a case of prerenal acute kidney injury (AKI) after COVID19 vaccination in a CKD patient using renin–angiotensin system inhibitor (RASi) and diuretics. An 87-year-old woman was inoculated with a second dose of the BNT162b2 mRNA COVID-19 vaccine 1 week before admission. After the second vaccination, she experienced loss of appetite, but continued medication. Two days before admission, she had difficulty in walking. On admission, she was transferred to the emergency department because of disorder of consciousness. Her medical history included hypertension, hyperlipidemia, CKD G4, chronic heart failure, and aortic stenosis. She was on carvedilol (5 mg/day), nifedipine (40 mg/day), telmisartan (40 mg/day), allopurinol (200 mg/ day), furosemide (20 mg/day), trichlormethiazide (1 mg/ day), tolvaptan (7.5 mg/day), rosuvastatin (2.5 mg/day), lansoprazole (15 mg/day), and aspirin (100 mg/day). On admission, the Glasgow Coma Scale (GCS) score was 7/15. Her temperature was 35.9 °C; blood pressure, 78/38 mmHg; pulse, 49 beats/min; respiratory rate, 20 breaths/min; and oxygen saturation, 100% on administered oxygen (6 L/min, mask). Physical examination was unremarkable, except for systolic murmur and dry mouth. Her body weight was 37.2 kg. Laboratory findings are presented in Table 1. Electrocardiogram showed a…
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